Ravi K Vuthoori

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Journals/Publications

• Heaney, C., Knisel, A., Vuthoori, R., Golombeck, D., Fernandez, H., Lima, B., Taylor, J., Davidson, K., Kennedy, K., Nursey, V., Miller, E., & Maybaum, S. (2023). Subjective Assessment Underestimates Fraility in Patients With Heart Failure Referred for Advanced Therapies. ASAIO journal (American Society for Artificial Internal Organs : 1992), 69(6), 588-594.
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  Assessment of frailty is key for evaluation for advanced therapies (ATs). Most programs use a subjective provider assessment (SPA) or "eye-ball" test; however, objective measures exist. The modified five-item Fried Frailty Index (mFFI) is a validated tool to assess frailty. We compared SPA to mFFI testing in patients referred for AT. We also compared levels of macrophage migration inhibitory factor (MIF), an inflammatory biomarker associated with worse outcomes in heart failure, between frail and not frail subjects. Seventy-eight patients referred for evaluation for AT underwent both SPA and mFFI testing. Three cardiac surgeons independently assessed patients for frailty (SPA). SPA significantly underestimated frailty compared with mFFI testing and correlation between SPA and mFFI was not strong (κ = 0.02-0.14). Providers were correct 84% of the time designating a subject as frail, but only 40% of the time designating as not frail. Agreement between all three providers was robust (76%), which was primarily driven by designation as not frail. There was no significant difference in plasma MIF levels between frail and not frail subjects (47.6 ± 25.2 vs . 45.2 ± 18.9 ng/ml; p = 0.6). Clinicians significantly underestimate frailty but are usually correct when designating a patient as frail.
• Vuthoori, R., Heaney, C., Lima, B., Knisel, A., Miller, E., Kennedy, K., Majure, D., Stevens, G., Bocchieri, K., Cassiere, H., Fernandez, H., & Maybaum, S. (2022). Assessment of cardiac recovery in patients supported with venoarterial extracorporeal membrane oxygenation. ESC heart failure, 9(4), 2272-2278.
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  Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to support patients in cardiogenic shock (CS). Early determination of disposition is paramount, as longer durations of support have been associated with worse outcomes. We describe a stepwise, bedside weaning protocol to assess cardiopulmonary recovery during VA-ECMO.
• Li, X., LeBlanc, J., Truong, A., Vuthoori, R., Chen, S. S., Lustgarten, J. L., Roth, B., Allard, J., Ippoliti, A., Presley, L. L., Borneman, J., Bigbee, W. L., Gopalakrishnan, V., Graeber, T. G., Elashoff, D., Braun, J., & Goodglick, L. (2011). A metaproteomic approach to study human-microbial ecosystems at the mucosal luminal interface. PloS one, 6(11), e26542.
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  Aberrant interactions between the host and the intestinal bacteria are thought to contribute to the pathogenesis of many digestive diseases. However, studying the complex ecosystem at the human mucosal-luminal interface (MLI) is challenging and requires an integrative systems biology approach. Therefore, we developed a novel method integrating lavage sampling of the human mucosal surface, high-throughput proteomics, and a unique suite of bioinformatic and statistical analyses. Shotgun proteomic analysis of secreted proteins recovered from the MLI confirmed the presence of both human and bacterial components. To profile the MLI metaproteome, we collected 205 mucosal lavage samples from 38 healthy subjects, and subjected them to high-throughput proteomics. The spectral data were subjected to a rigorous data processing pipeline to optimize suitability for quantitation and analysis, and then were evaluated using a set of biostatistical tools. Compared to the mucosal transcriptome, the MLI metaproteome was enriched for extracellular proteins involved in response to stimulus and immune system processes. Analysis of the metaproteome revealed significant individual-related as well as anatomic region-related (biogeographic) features. Quantitative shotgun proteomics established the identity and confirmed the biogeographic association of 49 proteins (including 3 functional protein networks) demarcating the proximal and distal colon. This robust and integrated proteomic approach is thus effective for identifying functional features of the human mucosal ecosystem, and a fresh understanding of the basic biology and disease processes at the MLI.
• Gade-Andavolu, R., Comings, D. E., MacMurray, J., Vuthoori, R. K., Tourtellotte, W. W., Nagra, R. M., & Cone, L. A. (2004). RANTES: a genetic risk marker for multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England), 10(5), 536-9.
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  Regulated upon activation, normal T-cell expressed and secreted (RANTES) is a beta-chemokine and has been detected in brain lesions of multiple sclerosis (MS) patients. Considering its potential role in MS, we screened two functional polymorphisms in the proximal promoter region of the RANTES in MS patients versus controls.